Extra Corporal Membrane Oxygenation (ECMO) vs. Conventional Ventilation with Nitric Oxide in ARDS due to Infected Contused Lung

Abstract

Introduction: Lung contusion due to severe chest trauma considered major problem in the critical care. Not only because of common ARDS (Acute Respiratory Distress Syndrome) but also the devitalized lung tissue due to trauma is major cause of superadded infection. Especially if this lung ventilated for a long time. Ventilator associated pneumonia (VAP) occur in this lung characterized by being developed in short time (early VAP after 4 days only ventilation). And also very resistant to the conventional line of treatment compared to other causes of VAP. As the devitalized lung tissue full with proteinicious material from exudative and infiltrative phase of traumatic inflammation make the lung tissue highly susceptible for bacterial growth. The question is can ECMO be useful in this critical situation? or the conventional way of management of severe VAP is better. Aim of the work: To compare the efficacy and safety of usage ECMO compared to conventional ventilation with nitric oxide using protective strategy in patients with ARDS due to severe lung contusion following severe chest trauma complicated by VAP as regards controlling all parameters of both Murray and CPIS score and early weaning from the ventilator. Patients and methods: This a prospective double blind study done in King Abdulaziz specialist hospital between January 2015 and September 2018 in the intensive care unit on 60 patients chosen after 10 days from conventional ventilation due to ARDS from severe lung contusion those who had more than 3 on Murray score and 6 on CPIS allocated randomly in two groups. Group A (30 patients) continued on the same conventional ventilation but broad spectrum antibiotics according to qualitative sputum culture and nitric oxide were added on the management while group B (30 patients) put on ECMO and started antibiotics. The duration of the study last 16 days during this period the clinical parameters of both Murray score and CPIS were compared between the patients of both groups and recorded. Also both mortality and morbidity recorded. Morbidity considered in our study by no improvement in any or all clinical parameters of both Murray and CPIS scores and failure of weaning of patients from the ventilator at the studied period. Results: By comparing the clinical parameters of both Murray and CPIS scores in both groups all over the studied periods showed significant improvement in the APACH II score <10 of patients of group B (0 patient in group A and 7 patients in group B), significant improvement in arterial oxygen saturation >95 of group B (0 patient in group A, 8 patients from B), significant improvement in hypoxic index >300 of patients of group B (0 patient in group A and 9 patients in B), significant improvement in parenchymatous lung infiltrate in chest X-ray with less than one quadrant infiltration of group B (3 patients in group A and15 patients in B), significant improvement in lung compliance with >80 ml for 1 cm H2O pressure of group B (3 patients in group A and 20 patients in B), significant improvement in response of the lung to recruitment maneuver of group B (14 patients in group A and 20 patients in B), significant improvement in return core temperature to normal in group B (4 patients in group A and 12 patients in B), significant return of tracheal secretion to normal in group B (6 patients in group A and 22 patients in B), significant return leucocytic count to normal in group B (10 patients in group A and 19 patients in B), significant improvement in the number of patient had lower level of LDH from 100-200 U/L in group B (6,8,12 and 19 patients in group B compared to 0,0,1 and 4 patients) in group A in the studied periods, significant improvement in the number of patient had higher CRP 201-300 mg/L in group B (8,10,13 and 17 patients in group B compared to 9,8,7and 5 patients in group A) significant improvement in the number of patient had negative sputum culture in group B (6 patients in group A and 17 patients in B), significant higher number of weaned patients in group B (15 from 27 patients in group A and19 from 26 patients in B), but unfortunately mortality rate was higher in group B (4 patients died) compared to group A (3 patients died). Conclusion: ECMO significantly improve all clinical parameters of both Murray and CPIS score and significantly increase number of weaned patients from ventilator but with higher mortality. J o u r n a l o f A ne sth esia & Cical es e a r c h ISSN: 2155-6148 Journal of Anesthesia and Clinical Research Allam et al., J Anesth Clin Res 2018, 9:11 DOI: 10.4172/2155-6148.1000867 Research Article Open Access J Anesth Clin Res, an open access journal ISSN:2155-6148 Volume 9 • Issue 11 • 1000867